Individual
LOGAN PLUCKEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IP
Contact information
Practice address
7557 W USTICK RD, BOISE, ID 83704-5810
(208) 890-4405
Mailing address
443 E HEARTHSTONE DR, BOISE, ID 83702-1727
(208) 890-4405
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
ID
Other
Enumeration date
08/26/2025
Last updated
08/26/2025
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